For Providers

By the numbers

Published On 11/17/2014

Hospitalizations and Emergency Department visits are down for high-risk asthma patients enrolled in Le Bonheur’s CHAMP (Changing High-Risk Asthma in Memphis through Partnership). The program is funded by a $2.9 million Health Care Innovation Grant from the Centers of Medicare and Medicaid (CMS) and aims to improve the quality of life of its enrollee – children living with uncontrolled asthma in Memphis. Preliminary results show health care utilization and health care costs are down. Each enrollees sets his or her own baseline, using TennCare (Tennessee’s Medicaid program) data. These figures are reported regularly to CMS.

Prior to entry into the CHAMP program, on average of 20 percent of the children visited the Emergency Department (ED) because of asthma at least once every three months. Once enrolled, the number dropped to 13 percent, across all quarters. CHAMP tracks ED Utilization among its enrollees quarterly (blue line) in relation to the baseline (red line). This change from an average of 20 to 13 percent is a 35 percent reduction in the percentage of children who have visited the ED at least once a quarter, exceeding CHAMP’s goal of a 15 percent reduction.

At the end of each quarter, the percentage of CHAMP children who have visited the Emergency Department or Urgent Care at least once is calculated for the previous six months. Prior to CHAMP, the average of children who visited an ED or Urgent Care at least once within a six-month period was 45 percent. The average of our quarterly percentages between the third and ninth quarter is 25 percent. This demonstrates a 44 percent reduction in the percentage of children who had at least one ED or Urgent Care within a six-month period while in the CHAMP program.

CHAMP tracks asthma-related hospitalizations that follow within seven days of an asthma-related ED, Urgent Care or Observation stay. The rationale behind this measure is that if you have been treated and released due to asthma, your episode should be controlled enough after discharge from the first visit so that you will not need to return. Returns within 7 days are considered part of the first episode and represent a breakdown in the quality of care of the first visit. CHAMP had zero avoidable asthma-related hospitalizations for the past two quarters. With the changes in health care, soon hospitals will be penalized for readmissions for the same diagnosis within certain timeframes. In the future, these avoidable hospitalizations may no longer be reimbursed by health care. This is to encourage facilities to help their patients better manage their chronic condition better. CHAMP is a CMS innovation project that works to do exactly that, help patients manage their asthma so that there is less hospital utilization.

Prior to entry into the CHAMP program, 10 percent (red line) of participants each quarter had at least one inpatient or observation stay related to asthma. While in the program, the percentage of participants who are hospitalized at least once a quarter has dropped to 6 percent (blue line). This represents a 40 percent reduction in the percentage of children hospitalized as quarter due to asthma, well below the program’s goal of a 15 percent reduction (purple line).